scholarly journals Saving sight in China and beyond: the Lifeline Express model

2018 ◽  
Vol 3 (4) ◽  
pp. e000766 ◽  
Author(s):  
Ian Yat Hin Wong ◽  
Michael Yuxuan Ni ◽  
Irene Oi Ling Wong ◽  
Nellie Fong ◽  
Gabriel M Leung
Keyword(s):  
Diabetic Retinopathy ◽  
Cataract Surgery ◽  
Large Scale ◽  
Rural China ◽  
Adult Population ◽  
Early Screening ◽  
Diabetic Retinopathy Screening ◽  
Health Strategy ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Cataract and diabetic retinopathy are leading causes of blindness globally. Lifeline Express (LEX) has pioneered the provision of cataract surgery in rural China from custom-built trains and eye centres nationwide. Over the past two decades, LEX has provided free cataract surgery for over 180 000 patients in China. In China, half of the adult population has prediabetes and 113 million adults have diabetes. Recognising the rising threat of diabetic retinopathy, LEX has expanded to providing free diabetic retinopathy screening nationwide by establishing 29 Diabetic Retinopathy Screening Centres across China. Source of referrals included host hospitals, the community and out-reach mobile vans equipped with fundus cameras. Fundi photos taken in the mobile vans were electronically transferred to primary graders. LEX also leveraged the widespread smartphone use to provide electronic medical reports via WeChat, the most popular instant messenger app in China. From April 2014 to December 2016, 34 506 patients with diabetes underwent screening, of which 27.2% (9,396) were identified to have diabetic retinopathy. China’s latest national health strategy (‘Healthy China 2030 Plan’) has championed the ‘prevention first’ principle and early screening of chronic diseases. LEX has accordingly evolved to extend its services to save sight in China—from cataract surgery to diabetic retinopathy screening and most recently outreaching beyond its national borders in a pilot South–South collaboration. With health at the top of the China’s developmental agenda and the country’s growing role in global health—LEX’s large-scale telemedicine-enabled programme could represent a potentially scalable model for nationwide diabetic retinopathy screening elsewhere.

scholarly journals Utilization of diabetic retinopathy screening among diabetic patients at a tertiary care hospital in Kerala, India

2021 ◽  
Vol 8 (10) ◽  
pp. 4938
Author(s):  
Sona Sabitha Kumar ◽  
Lathika Vasu Kamaladevi ◽  
Sruthi Mankara Valsan
Keyword(s):  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Adult Population ◽  
Tertiary Care ◽  
Health Concern ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Screening Programs ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening

Background: Diabetes is a major public health concern that affects nearly 463 million (9.3%) of global adult population. Diabetic retinopathy, which affects around 35% of all diabetic patients, is the fifth leading cause of preventable global blindness. This study was done to determine the status of diabetic retinopathy screening and the factors that influence its uptake among diabetic patients attending a tertiary care setting in Kerala, India.Methods: 200 patients with diabetes mellitus on physician care were enrolled for a questionnaire-based survey which collected information on patient demographics, education, occupation, patient’s awareness of retinopathy, screening, diabetic blindness and their source of such knowledge.Results: 83% were aware that diabetes can result in vision loss. 61% were aware that diabetic blindness is preventable. 42% patients were aware of screening options for retinopathy. The awareness of retinopathy screening was significantly associated (p=0.0001) only with duration of diabetes.Conclusions: Awareness of diabetic retinopathy among diabetic patients in Kerala was sub optimal. Better patient education and use of mass media can increase awareness on diabetes retinopathy screening programs. 

Improving Access to Diabetic Retinopathy Screening through Telemedicine (Preprint)

2020 ◽  
Author(s):  
Shuja Rayaz ◽  
Tiffany Wandy ◽  
Jenna Brager ◽  
Michael Kiritsy ◽  
Daniel Durand
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Care Setting ◽  
Vision Loss ◽  
Primary Care Setting ◽  
Adult Population ◽  
Descriptive Study ◽  
Pilot Program ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening

BACKGROUND Screening for diabetic retinopathy is important for the prevention of blindness among the adult population. Currently, patients with diabetes require a referral from their primary care physician to see an ophthalmologist for their annual eye exam, which can be an added inconvenience. As such, there is a need for alternative screening strategies within an outpatient network. The use of a telemedicine platform in a primary care network serves as a novel strategy to increase diabetic retinopathy screening rates. LifeBridge Health operates two Track 1 Accountable Care Organizations with a combined attribution of approximately 28,000 patients. Many value-based care and pay for performance programs use diabetic retinopathy screening rate as a quality measure. In order to provide better access to diabetic retinopathy screening for our patients, three specialized cameras were placed in three primary care practices in October 2017 as part of a pilot program. The online Intelligent Retinal Imaging Systems (IRIS) platform was utilized as a secure data warehouse of images that could be interpreted remotely by an ophthalmologist within the LifeBridge Health network for the diagnosis of diabetic retinopathy or detecting other types of pathology (e.g. macular edema). OBJECTIVE The aim of this retrospective descriptive study was to examine if a telemedicine platform can be used to increase diabetic retinopathy screening rates in the primary care setting. METHODS Three distinct datasets corresponding with three time periods were examined for this study. Pre-post comparison examined screening rates from all practices from January 2018 – December 2018 to those of January 2017 – December 2017. The pilot program dataset examined screening rates in the practices before and after the implementation of the IRIS cameras in October 2017. Aggregate diagnostic data from the IRIS online dashboard from October 2017- December 2019 was also examined to determine the benefit of the IRIS platform since the initial implementation. RESULTS Pre-post comparison screening rates showed mean screening rates of 38.5% and 47.2%, respectively, indicating an 8.7% improvement in screening. The pilot program showed improved screening rates at each outpatient practice with the implementation of the IRIS cameras. Aggregate data since the implementation of the IRIS cameras showed that, of the 1213 patients who were screened, approximately 17.1% (n=207 patients) were diagnosed with diabetic retinopathy and an additional17.7% (n=215 patients) were suspected of having some form of other pathology. 10.1% (n=123 patients) were also suspected to be at risk for imminent vision loss. CONCLUSIONS This retrospective descriptive study suggests that a telemedicine platform can be used to improve diabetic retinopathy screening rates in the primary care setting within a large healthcare system.

scholarly journals Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting

2020 ◽  
Vol 8 (1) ◽  
pp. e001154
Author(s):  
George Bresnick ◽  
Jorge A Cuadros ◽  
Mahbuba Khan ◽  
Sybille Fleischmann ◽  
Gregory Wolff ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Complete Information ◽  
Persistent Problem ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
The Usa ◽  
Adherence Monitoring ◽  
Retinopathy Screening

IntroductionTelemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This study examined the extent of patients’ adherence to postscreening recommendations.Research design/methodsA retrospective record review was conducted in primary care clinics of a large county hospital in the USA. All patients with diabetes detected with VTDR in two time periods, differing in record type used, were included in the study: 2012–2014, paper charts only; 2015–2017, combined paper charts/electronic medical records (EMRs), or EMRs only. Adherence rates for keeping initial ophthalmology appointments, starting recommended treatments, and keeping follow-up appointments were determined.ResultsAdequate records were available for 6046 patients; 408 (7%) were detected with VTDR and recommended for referral to ophthalmology. Only 5% completed a first ophthalmology appointment within recommended referral interval, 15% within twice the recommended interval, and 51% within 1 year of DRS. Patients screened in 2015–2017 were more likely to complete a first ophthalmology appointment than those in 2012–2014. Ophthalmic treatment was recommended in half of the patients, of whom 94% initiated treatment. A smaller percentage (41%) adhered completely to post-treatment follow-up. Overall, 28% of referred patients: (1) kept a first ophthalmology appointment; (2) were recommended for treatment; and (3) initiated the treatment. Most patients failing to keep first ophthalmology appointments continued non-ophthalmic medical care at the institution. EMRs provided more complete information than paper charts.ConclusionsReducing vision impairment from VTDR requires greater emphasis on timely adherence to ophthalmology referral and follow-up. Prevention of visual loss from VTDR starts with retinopathy screening, but must include patient engagement, adherence monitoring, and streamlining ophthalmic referral and management. Revision of these processes has already been implemented at the study site, incorporating lessons from this investigation.

scholarly journals Factors associated with non-attendance in the Irish national diabetic retinopathy screening programme (INDEAR study report no. 2)

2021 ◽  
Author(s):  
Stephen R. Kelly ◽  
Allison R. Loiselle ◽  
Rajiv Pandey ◽  
Andrew Combes ◽  
Colette Murphy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Intervention Strategy ◽  
Cost Effective ◽  
Missed Appointments ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Abstract Aims We aimed to determine the patient and screening-level factors that are associated with non-attendance in the Irish National Diabetic Retinal screening programme (Diabetic RetinaScreen). To accomplish this, we modelled a selection of predictors derived from the historical screening records of patients with diabetes. Methods In this cohort study, appointment data from the national diabetic retinopathy screening programme (RetinaScreen) were extracted and augmented using publicly available meteorological and geospatial data. A total of 653,969 appointments from 158,655 patients were included for analysis. Mixed-effects models (univariable and multivariable) were used to estimate the influence of several variables on non-attendance to screening appointments. Results All variables considered for analysis were statistically significant. Variables of note, with meaningful effect, were age (OR: 1.23 per decade away from 70; 95% CI: [1.22–1.24]), type 2 diabetes (OR: 1.10; 95% CI: [1.06–1.14]) and socio-economic deprivation (OR: 1.12; 95% CI: [1.09–1.16]). A majority (52%) of missed appointments were from patients who had missed three or more appointments. Conclusions This study is the first to outline factors that are associated with non-attendance within the Irish national diabetic retinopathy screening service. In particular, when corrected for age and other factors, patients with type 2 diabetes had higher rates of non-attendance. Additionally, this is the first study of any diabetic screening programme to demonstrate that weather may influence attendance. This research provides unique insight to guide the implementation of an optimal and cost-effective intervention strategy to improve attendance.

scholarly journals Improving Patient Access to Diabetic Retinopathy Screening Through Telemedicine

Iproceedings ◽  
10.2196/15193 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15193
Author(s):  
Tiffany Wandy ◽  
Michael Kiritsy ◽  
Daniel Durand
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Primary Care Practice ◽  
Primary Care Providers ◽  
Care Practice ◽  
Type I ◽  
Screening Measure ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Background The LifeBridge Health (LBH) Accountable Care Organization (ACO) serves approximately 20,000 Medicare beneficiaries, many of whom have type I or type II diabetes. Diabetic retinopathy (DR) screening is extremely important in helping to preserve patient’s eyesight and overall functional status. However, like many other organizations, LBH has struggled with low compliance rates for DR screening. As result, LBH searched for a solution to improve DR screening care and improve ACO quality and financial performance. Objective LifeBridge sought a telemedicine diagnostic solution that was easy for our physicians and clinic teams to use that would enable improved management of patients with diabetes. A pilot was initiated at three large primary care practice locations in the last quarter of 2017. Two of the locations received table top cameras, while the other location received a more mobile, hand held unit. Working with a dedicated LBH IRIS team, the practices created and implemented workflows, documented processes, and instilled best practices. Methods We used a pre-post test design to measure whether implementation of this tool enabled providers to better meet the diabetic retinopathy screening measure. We included the final months of 2017 in the preperiod to account for any operational changes required to implement the new workflow. Manual chart abstraction of patients seen in the previous 4/6 weeks who were eligible to determine the proportion of patients who met the measure. This was done quarterly in every primary care practice throughout the organization. One of the three practice sites was changed halfway through 2018 and switched to another; however, both practices were included in the analysis. We also compared the number of diabetes patients in the populations of each of the four practices. A two sample z test with a P value of .05 was used to test for statistical significance. Results As of April 2019, 810 patients were screened for diabetic retinopathy. Of these, 33.1% (282 patients) were diagnosed with pathology. Approximately 15.6% (n=133) were diagnosed with DR. We also identified 87 patients who are considered “IRIS saves” patients who had pathology identified that was serious enough to put them at imminent risk of losing their sight. For all patients requiring follow up, direct referrals were made to our in-network ophthalmologists at Krieger Eye Institute for treatment that these patients would not have otherwise received. Statistical comparison of DR screening performance of practices pre and post implementation showed mean screening rates of 38.5% and 47.2%, respectively, with P=.01. Conclusions IRIS screenings allowed our primary care providers to provide more comprehensive care to patients with diabetes, eliminating the need for additional office visits. Having IRIS available in the practice was able to demonstrably improve performance in the diabetic retinopathy screening measure. As a result, primary care providerss with IRIS helped facilitate access to care, thus making it easier for patients make better choices related to their health outcomes. We hope to further use the data to study HbA1c control, medication adherence, and cost/utilization in those diagnosed with retinopathy compared to those with a negative screening.

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